Why does my gum hurt years after wisdom tooth removal?

gum pain
After wisdom tooth removal, everything should be back to normal. Swelling and pain should gradually decrease, and your gums will return to their normal appearance within a few weeks.

If pain persists longer than expected, you need to visit your dentist. Many oral and facial conditions can cause this type of pain. Some forms may be constant and persist for weeks or months or return periodically with the same symptoms for years.

Only a professional examination can determine the exact cause and the appropriate treatment for you.

Understanding the origin of pain that comes from the mouth

jaw innervation
Pain is typically a response of our body to aggression or an injury. It occurs after the stimulation of certain receptors called nociceptors. These are nerve endings found in the skin, superficial tissues, and all organs. They can transmit nociceptive information to the brain which interprets it as pain.

The nerve responsible for oral pain is called the trigeminal nerve. Depending on the type of the injury, the pain can be localized, diffuse, moderate, or severe. The most important mechanism of oral pain is nociception. The nociceptive receptors in the mouth can be stimulated by injury or direct aggression by infection such as caries, gum disease, dental abscess, or trauma.

In rare situations, pain occurs without an apparent lesion or injury in the mouth. These types of unexplained pain are called atypical.
The mechanisms involved are still unclear. Some authors suggest that it has no cause. Others associate it with psychological factors such as depression and anxiety. But, most agree that it comes from an affection of a nerve portion or alteration of the central nervous system responsible for interpreting pain.
This results in sensitivity disorders. The pain may be amplified and felt like an electrical shock or burning of the affected area.

The possible causes of pain that occur years after a wisdom tooth extraction

Pain that suddenly appears years after a wisdom tooth extraction can have different meanings.

It is not necessarily related to the extraction procedure. Certain dental conditions such as gum disease, apical periodontitis, and pulpitis affecting other teeth can cause pain to spread throughout the jaw, including the extraction site. In other less common situations, a major nerve may be injured during the procedure, resulting in sensory disturbances. Symptoms may include loss or intensification of painful sensations.

Among the possible causes of the pain that appears several years after a wisdom tooth extraction:

Caries or dental fractures

tooth layers
Caries are a disease that affects the hard tissues of the teeth, including the enamel, which is the outermost layer of the tooth, and the dentin that lies just below it.
If left untreated, cavities will continue to progress toward the pulp where the nerves and blood vessels of the tooth are located.

As for the fracture, it creates a direct entrance for bacteria to the pulp. The bacteria will penetrate the tooth through the cracks and cause a dental infection.

The condition where the pulp is affected is called pulpitis. It is known to cause severe, stabbing pain. The pain can also spread to the surrounding teeth and even to the jaws, temporomandibular joint, and ear, making it hard to identify the exact origin of the pain.

Treatment of pulpitis consists of removing the decay and infected pulp, then filling the tooth with a dental material to restore and protect it.

Gum disease

advanced stage of gum disease
The most common gum diseases are gingivitis and periodontitis. They occur mainly due to the invasion of the gums by virulent bacteria of the mouth.
Our body to defend itself will trigger inflammation. These reactions will result in damage to the tissues surrounding the teeth.

The bone of the jaws will progressively resorb, leading to tooth loss. Indeed, gum diseases are the first cause of tooth loss in adults.

Receding gums and tooth loosening can cause sensitivity. This may give you the impression that the wisdom tooth extraction site is painful when actually the sensitivity is the result of gum disease, especially if the nearest tooth (2nd molar) is receding.
The most common symptoms of gum disease are:

  • Redness and swelling of the gums
  • Bleeding when you eat or brush your teeth
  • Gum sensitivity
  • Gum recession, loosening of teeth (teeth appear longer), and tooth mobility
  • Pus discharge around the teeth
  • Bad breath
  • Teeth shifting leading to an incorrect bite

The treatment of gum disease involves eliminating the cause. Oral hygiene measures and professional dental cleaning can remove plaque and tartar, which are the main factors in gingivitis and periodontitis. Your dentist may also prescribe a mouthwash and an antibiotic to complement the manual cleaning.

Muscle and joint pain

jaw muscles and joints pain
Another cause of the pain is damage to the muscles and joints of the jaws. The procedure of wisdom tooth extraction requires a wide opening of the mouth. The technique and the duration of the operation can lead to different problems in your jaws.

You may experience persistent muscle and joint pain that may prevent you from opening your mouth normally. Pain increases during normal oral functions such as chewing, speaking, and swallowing.

Atypical odontalgia

Atypical odontalgia or phantom tooth pain, compared to other conditions, is relatively uncommon, affecting 0.03% to 1% of the population, primarily women after 40 years of age, due to hormonal factors.

According to the International Headache Society (IHS), it is a constant pain located in one or more teeth or extraction sites in the absence of any identifiable cause. It is so-called because it occurs in healthy areas, which can be confusing for you and your dentist.

In 83% of cases, atypical odontalgia occurs after oral surgery such as extraction. It is estimated that 3-6% of people who have had a root canal had phantom tooth pain. This can worsen the situation because dental procedures do not solve the problem. Instead, the pain can spread and evolve into the surrounding areas. You will then point to another tooth that will in turn be treated or extracted, turning the atypical toothache into a diffuse facial pain.

Usually, the pain is present for more than 6 months and can recur periodically for several years. It usually appears after a procedure likely to injure a nerve and persists despite dental procedures.

Over-the-counter painkillers, anti-inflammatory drugs, and local anesthesia may not be effective as well, which explains the involvement of the entire nervous system in this condition.

The pain is continuous with an intensity that can vary from slight to severe. But in most cases, the pain is moderate and should not prevent you from sleeping. It feels like a burning and throbbing sensation, triggered on its own without stimulation by cold, heat, or chewing.

The treatment of atypical odontalgia consists in relieving the pain. The most commonly used medications are tricyclic antidepressants. The treatment starts with low doses and continues for several months before gradually decreasing the doses again. Improvement may occur within a few days to a few weeks after starting treatment.

The mechanisms involved in this condition are not well known, which makes its diagnosis and treatment more challenging.

Keep in mind that if you experience persistent oral pain for months or years on a seemingly healthy tooth or extraction site, chances are you are dealing with atypical odontalgia. The best thing to do is to see your dentist for a thorough examination.